<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604340
Report Date: 10/26/2021
Date Signed: 10/27/2021 11:20:04 AM

Document Has Been Signed on 10/27/2021 11:20 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:GARCIA'S ARFFACILITY NUMBER:
374604340
ADMINISTRATOR:GARCIA, YASMINE H.FACILITY TYPE:
735
ADDRESS:1620 PEPPER DRTELEPHONE:
(619) 392-8863
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY: 4CENSUS: 4DATE:
10/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Licensee Yasmine GarciaTIME COMPLETED:
03:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPA's) Dang Nguyen and Sabel Martinez conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA's were welcomed by Licensee Yasmine Garcia, identified themselves, and discussed the purpose of the visit.

LPA's conducted a brief tour of the facility and observed the staff and residents in care. In accordance with the Department’s Infection Control program, LPA's provided technical assistance and observed and evaluated the facility's implementation of their COVID-19 Mitigation Plan, to include disinfection, screening protocols, and the use of personal protective equipment. No deficiencies were cited on this date.

An exit interview was conducted with Licensee Yasmine Garcia, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided via E-mail
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1